NURS 629 Peds Questions and Answers Latest Update Graded A+ (Maryville University)

A dipstick urinalysis is positive for leukocyte esterase and nitrites in a schoolage child with dysuria and foulsmelling urine but no fever who has not had previous urinary tract infections. A culture is pending. What will the pediatric nurse practitioner do to treat this child?: Ans- Prescribe trimethoprimsulfamethoxazole (TMP) twice daily for 3 to 5 days 3. the parent of a 4monthold infant is concerned that the infant cannot hear. Which test will the primary care pediatric nurse practitioner order to evaluate potential hearing loss in this infant?: Ans- Auditory brainstem response (ABR) 4. 4. The primary care pediatric nurse practitioner attempts to learn more about the ID: Ans- 42 emotional health of an 18monthold child through which assessment strategy?: Ans- Observation of the child with caretakers in structured and unstructured situations 5. 6. What will the primary care pediatric nurse practitioner teach the parents of a child who has new pressureequalizing tubes (PET) in both ears?: Ans- Parents should notice improved hearing in their child. 6. 4. A preschoolage child with no previous history has mild flank pain and fever but no abdominal pain or vomiting. A urinalysis is positive for leukocyte esterase and nitrites. A culture is pending. Which is the correct course of treatment for this child?: Ans- Order amoxicillin clavulanate 7. 7. A child with a history of otitis externa asks about ways to prevent this condition. What will the primary care pediatric nurse practitioner recommend?: AnsDrying the ear canal with a hair dryer 8. 12. The primary care pediatric nurse practitioner is evaluating recurrent stomach pain in a schoolage child. The child's exam is normal. The nurse practitioner learns that the child reports NURS 629 Peds Q&A for all 4 test combined Maryville University 2022/23 2 / 57 pain most evenings after school and refuses to participate in sports but does not have nausea or vomiting. The child's grandmother recently had gallbladder surgery. Which action is correct?: Ans- Encourage the child to keep a log of pain, stool patterns, and dietary intake 9. 9. A child who has otitis externa has severe swelling of the external auditory canal that persists after 2 days of therapy with ototopical antibiotic/corticosteroid drops. What is the next step in treatment for this child?: AnsInsert a wick into the external auditory canal. 10. 5. A 3yearold child has just completed a 7day course of amoxicillin for a secondfebrile urinary tract infection and currently has a negative urine culture. What is the next course of action?: Ans- Obtain a renal and bladder ultrasound. 11. 8. A child complains of itching in both ears and is having trouble hearing. The primary care pediatric nurse practitioner notes periauricular edema and marked swelling of the external auditory canal and elicits severe pain when manipulating the external ear structures. Which is an appropriate intervention?: Ans- Order ototopical antibiot- ic/corticosteroid drops. 12. 5. A middleschoolage child is skipping school frequently and getting poor grades since the child's father was killed while deployed in the military. How will the primary care pediatric nurse practitioner manage this situation?: Ans- Refer the child to a mental health specialist for evaluation and treatment. 13. The primary care pediatric nurse practitioner is examining a 2weekold infant and auscultates a wide splitting of S 2 during expiration. What condition may this finding represent?: Ans- Atrial septal defect 14. A 9monthold infant with a history of three urinary tract infections is diagnosed with grade II vesicoureteral reflux. Which medication will be prescribed?: Ans- TMPSMX~ TMP 2 mg/kg as a single daily dose 15. 2. The primary care pediatric nurse practitioner auscultates a new grade II vibratory, midsystolic murmur at the mid sternal border in a 4yearold child that is NURS 629 Peds Q&A for all 4 test combined Maryville University 2022/23 3 / 57 louder when the child is supine. What type of murmur is most likely?: Ans- Still's murmur 16. 4. The primary care pediatric nurse practitioner is performing a well baby examination on a 2monthold infant who has gained 25 grams per day in the last interval. The mother is nursing and tells the nurse practitioner that her infant seems fussy and wants to nurse more often. What will the nurse practitioner tell her?: Ans- The infant may be going through an expected growth spurt. 17. 3. During a well child assessment, the primary care pediatric nurse practitioner auscultates a harsh, blowing grade IV/VI murmur in a 6monthold infant. What will the nurse practitioner do next?: Ans- Refer to a pediatric cardiologist for further evaluation 18. 12. A child who has nephrotic syndrome is on a steroids and a saltrestricted diet for a relapse of symptoms. A dipstick urinalysis shows 1+ protein, down from 3+ at the beginning of the episode. In consultation with the child's nephrologist, what is the correct course of treatment considering this finding?: Ans- Continue with steroids and salt restrictions until the urine is negative for protein 19. 4. The primary care pediatric nurse practitioner provides primary care for a 4month old infant who has a ventricular septal defect. The infant has been breastfeeding well but in the past month has dropped from the 20th percentile to the 5th for weight. What will the nurse practitioner recommend?: Ans- Fortifying breast milk to increase the number of calories per ounce 20. 6. The parent of a 4yearold child reports that the child seems to be having trouble adjusting to a new day care and reportedly is always engaging in solitary play when the parent arrives to pick up the child. What will the primary care pediatric nurse practitioner do?: Ans- Ask the parent if the child is slow to warm up to other new situations 21. 5. A 12monthold infant who had cardiopulmonary bypass with RBC and plasma NURS 629 Peds Q&A for all 4 test combined Maryville University 2022/23 4 / 57 infusions during surgery at 8 months is seen for a well child examination. Which vaccine may be administered at this visit?: Ans- PCV13 22. 13. A child who had GABHS 2 weeks prior is in the clinic with periorbital edema, dyspnea, and elevated blood pressure. A urinalysis reveals teacolored urine with hematuria and mild proteinuria. What will the primary care pediatric nurse practitioner do to manage this condition?: Ans- Refer the child to a pediatric nephrologist for hospital- ization. 23. The primary care pediatric nurse practitioner performs a well child examination on a 12monthold child who had repair of a congenital heart defect at 8 months of age. The child has a normal exam. The parent reports that the child is not taking any medications. The nurse practitioner will contact the child's cardiologist to discuss whether the child needs which medication?: Ans- Amoxicillin 24. 7. The primary care pediatric nurse practitioner sees a developmentally delayed toddler for an initial visit. The family has just moved to the area and asks the nurse practitioner about community services and resources for their child. What should the nurse practitioner do initially?: Ans- Ask the parents if they have an individualized family service plan (IFSP). 25. 20. A 7yearold child who has a history of a repaired congenital heart defect has many dental caries along with gingival erythema and irritation and a temperature of 102.5°F. What will the primary care pediatric nurse practitioner do next?: Ans- Ad- mit to the hospital with a pediatric cardiology consult. 26. 16. A 6monthold infant has a retractile testis that was noted at the 2month well baby exam. What will the primary care pediatric nurse practitioner do to manage this condition?: Ans- Refer the infant to a pediatric urologist or surgeon for possible orchiopexy NURS 629 Peds Q&A for all 4 test combined Maryville University 2022/23 5 / 57 27. 21. A 15yearold female reports fainting at school in class on two occasions. The adolescent's orthostatic blood pressures are normal. The primary care pediatric nurse practitioner suspects a cardiac cause for these episodes and will order which tests before referring her to a pediatric cardiologist?: Ans- 12lead electrocardiogram 28. 7. The parent of a schoolage child is concerned because the child has started to express anger about a grandparent's death even though this occurred when the child was a toddler. What will the primary care pediatric nurse practitioner tell the parent?: Ans- The significance of this loss must be reworked at each developmental level 29. 7. During a well baby examination of a 6weekold infant, the primary care pediatric nurse practitioner notes poor weight gain, acrocyanosis of the hands and feet, and a respiratory rate of 60 breaths per minute. Oxygen saturation on room air is 93%. The remainder of the exam is unremarkable. Which action is correct?: Ans- Refer the infant to a pediatric cardiologist 30. 14. An adolescent has rightsided flank pain without fever. A dipstick urinalysis reveals gross hematuria without signs of infection or bacteriuria, and the primary care pediatric nurse practitioner diagnoses possible nephrolithiasis. What is the initial treatment for this condition?: Ans- Increasing fluid intake up to 2 L daily 31. 8. A 3monthold infant who was previously healthy now has a persistent cough, bilateral lung crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a grade III/VI, lowpitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely?: Ans- Ventricular septal defect 32. 6. The mother of a 15yearold adolescent female tells the primary care pediatric nurse practitioner that her daughter has extreme mood swings prior to her periods, which the adolescent vehemently denies. When asked if she notices anything different NURS 629 Peds Q&A for all 4 test combined Maryville University 2022/23 6 / 57 just before her periods, the adolescent points to her mother and says, "She NURS 629 Peds Q&A for all 4 test combined Maryville University 2022/23 7 / 57 gets really hard to live with." This demonstrates which characteristic of adolescent thinking?: Ans- Apparent hypocrisy 33. 9. An infant with trisomy 21 has a complete AV canal defect. Which finding, associated with having both of these conditions, will the primary care pediatric nurse practitioner expect?: Ans- Oxygen desaturation 34. 15. During a well child examination of a 2yearold child, the primary care pediatric nurse practitioner palpates a unilateral, smooth, firm abdominal mass which does not cross the midline. What is the next course of action that?: Ans- Refer the child to an oncologist immediately. 35. 10. A 9monthold infant has a grade III/VI, harsh, rumbling, continuous murmur in the left infraclavicular fossa and pulmonic area. A chest radiograph reveals cardiac enlargement. The primary care pediatric nurse practitioner will refer the infant to a pediatric cardiologist and prepare the parents for which intervention to repair this defect?: Ans- Coil insertion in the catheterization laboratory 36. 8. The parent of a schoolage child reports that the child doesn't like being alone in rooms because of a fear of aliens hiding in closets. What will the primary care pediatric nurse practitioner tell the parent?: Ans- "Fear of imaginary creatures does not usually occur at this age." 37. A 5yearold child who had a repair for transposition of the great arteries shortly after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner notes mild shortness of breath with exertion and, upon questioning, learns that the child has recently complained of dizziness. What will the nurse practitioner do?: Ans- Refer the child to the cardiologist immediately 38. 17. A 9monthold infant is brought to the clinic with scrotal swelling and fussiness. The primary care pediatric nurse practitioner notes a tender mass in the affected scrotum that is NURS 629 Peds Q&A for all 4 test combined Maryville University 2022/23 8 / 57 difficult to reduce. What is the correct action?: Ans- Refer immediately to a pediatric surgeon 39. 7. A 6yearold child has a systolic blood pressure between the 95th and 99th percentile for age, sex, and height and a diastolic blood pressure between the 90th and the 95th percentile on three separate clinic visits. This child's blood pressure is classified as: Ans- stage 1 hypertensive 40. 8. The primary care pediatric nurse practitioner is counseling a parent about bicycle helmet use. The parent reports having a helmet used a year previously by an older child and wonders about using it for a younger child since they are so expensive. What will the nurse practitioner tell the parent?: Ans- "If the helmet is free from marks, you may use it." 41. 12. The primary care pediatric nurse practitioner is performing a well child examination on a schoolage child who had complete repair of a tetralogy of Fallot defect in infancy. What is important in this child's health maintenance regime?: AnsCardi- ology clearance for sports participation 42. 18. The mother of a 12monthold uncircumcised male infant reports that the child seems to have pain associated with voiding. A physical examination reveals a tight, pinpoint opening of the foreskin, which thickened and inflamed. What will the primary care pediatric nurse practitioner do?: AnsRefer the child to a pediatric urologist. 43. 19. A 12yearold child whose BMI is greater than the 95th percentile has a blood pressure at the 98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise, the child's BMI drops to the 90th percentile, but the blood pressure remains the same. What is the primary care pediatric nurse practitioner's next step in treating this child?: Ans- Referral to a nephrologist or cardiologist 44. 9. The parent of a preschoolage child reports that the child often appears anxious and nervous and that this is associated occasionally with a rapid heart rate and tremors. What is the best type of referral that the primary care pediatric nurse practitioner could recommend?: Ans- Play therapy NURS 629 Peds Q&A for all 4 test combined Maryville University 2022/23 9 / 57 45. 13. The primary care pediatric nurse practitioner is performing a sports physical on an adolescent whose history reveals mild aortic stenosis. What will the nurse practitioner recommend?: Ans- Evaluation by a cardiologist prior to participation 46. 19. An adolescent male comes to the clinic reporting unilateral scrotal pain, nausea, and vomiting that began that morning. The primary care pediatric nurse practitioner palpates a painful, swollen testis and elicits increased pain with slight elevation of the testis (a negative Phren's sign). What will the nurse practitioner do?: AnsRefer the adolescent immediately to a pediatric urologist or surgeon 47. 18. A 12yearold child whose weight and BMI are in the 75th percentile has a diastolic blood pressure that is between the 95th and 99th percentiles for age, sex, and height on three separate occasions. Initial tests for this child will include: Ans- renal function and plasma renin tests 48. 8. The parent of a 14yearold child tells the primary care pediatric nurse practitioner that the child skips classes frequently in spite of various disciplinary measures, such as grounding and extra homework and is earning Cs and Ds in most classes. What will the nurse practitioner recommend?: Ans- Evaluation for possible learning disorders 49. 16. An adolescent female has a history of repaired tetralogy of Fallot. Which long term complication is a concern for this patient?: Ans- Mitral valve prolapse 50. 11. A child is diagnosed with nephrotic syndrome, and the pediatric nurse practitioner provides primary care in consultation with a pediatric nephrologist. The child was treated with steroids and responded well to this treatment. What will the nurse practitioner tell the child's parents about this disease?: Ans- "Steroids will be used when relapses occur." 51. 15. A 5yearold child has an elevated blood pressure during a well child exam. The primary care pediatric nurse practitioner notes mottling and pallor of the child's feet and lower legs and auscultates a systolic ejection murmur in the left infraclavicular region radiating to the NURS 629 Peds Q&A for all 4 test combined Maryville University 2022/23 10 / 57 child's back. The nurse practitioner will suspect which condition?: AnsCoarcta- tion of the aorta 52. 10. A 9yearold child exhibits school refusal and a reluctance to attend sleepovers with classmates. The parent is concerned because the child has recently begun sleeping in the parents' bed. Which initial action by the primary care pediatric nurse practitioner is appropriate?: Ans- Assess for environmental stress, parental dysfunction, and mater- nal depression 53. 14. During a routine well child exam on a 5yearold child, the primary care pediatric nurse practitioner auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields. The child has normal growth and development. What will the nurse practitioner suspect?: Ans- Pulmonic stenosis 54. 7. The parent of a toddler diagnosed with grade V vesicoureteral reflux asks the primary care pediatric nurse practitioner how the disease will be treated. What will the nurse practitioner tell this parent?: Ans- That surgery to correct the condition is possible 55. In a respiratory disorder causing a checkvalve obstruction, which symptoms will be present?: Ans- Air entry on inspiration with expiratory occlusion 56. 7. The parent of a 5monthold is worried because the infant becomes fussy but doesn't always seem interested in nursing. What will the nurse practitioner tell this parent?: Ans- The infant may be expressing a desire to play or to rest. 57. 5. A schoolage child has an abrupt onset of sore throat, nausea, headache, and a temperature of 102.3°F. An examination reveals petechiae on the soft palate, beefyred tonsils with yellow exudate, and a scarlatiniform rash. A Rapid Antigen Detection Test (RADT) is negative. What is the next step in management for this child?: Ans- Perform a followup throat NURS 629 Peds Q&A for all 4 test combined Maryville University 2022/23 11 / 57 culture NURS 629 Peds Q&A for all 4 test combined Maryville University 2022/23 12 / 57 58. 9. A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. What diagnosis is most likely?: Ans- HenochSchönlein purpura 59. 2. A child has an acute infection causing lower airway obstruction. Which initial symptom is expected in this child?: Ans- Wheezing 60. 11. The parent of a schoolage child reports that the child becomes frustrated when unable to perform tasks well and often has temper tantrums and difficulty sleeping. Which disorder may be considered in this child?: Ans- Generalized anxiety disorder (GAD) 61. 3. A 4yearold child with an upper respiratory tract infection has cloudy nasaldischarge and moderate nasal congestion interfering with sleep. The parent asks what product to use to help with symptoms. What will the primary care pediatric nurse practitioner recommend?: Ans- Saline rinses 62. 10. An adolescent has 2+ proteinuria in a random dipstick urinalysis. A subsequent first morning voided specimen is negative. What will the primary care pediatric nurse practitioner do to manage this condition?: Ans- Monitor for proteinuria at each annual well child examination. 63. 4. A 5yearold child has enlarged tonsils and a history of four throat infections in the previous year with fever, cervical lymphadenopathy, and positive Group AStreptococcus pyogenes (GABHS) cultures. The parent reports that the child snores at night and expresses concerns about the child's quality of sleep. The next step in managing this child's condition is to: Ans- refer to a pulmonologist for polysomnography evaluation 64. A positive anterior or positive drawer test would be indicative of which injured ligament?: Ans- Cruciate ligament 65. An adolescent has suspected infectious mononucleosis after exposure to the virus in the past week. The primary care pediatric nurse practitioner examines the adolescent and notes exudate on the tonsils, soft palate petechiae, and diffuse adenopathy. Which test will the primary care pediatric nurse practitioner perform to confirm the diagnosis?: Ans- EBVspecific antibody testing 66. 8. A healthy 14yearold female has a dipstick urinalysis that is positive for NURS 629 Peds Q&A for all 4 test combined Maryville University 2022/23 13 / 57 56 RBCs per hpf but otherwise normal. What is the first question the primary NURS 629 Peds Q&A for all 4 test combined Maryville University 2022/23 14 / 57 care pediatric nurse practitioner will ask this patient?: Ans- "When was your last menstrual period (LMP)?"